Provider Demographics
NPI:1477647030
Name:PAYNE, MICHAEL DON (DPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DON
Last Name:PAYNE
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13000 ANDUIN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-2111
Mailing Address - Country:US
Mailing Address - Phone:405-834-4919
Mailing Address - Fax:405-691-7063
Practice Address - Street 1:921 NE 13TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5007
Practice Address - Country:US
Practice Address - Phone:405-456-5474
Practice Address - Fax:405-456-3681
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10341183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist